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[Therapeutic compliance in patients with cardiovascular diseases]
Mercedes García-Reyes Ramos1, Jesús López-Torres Hidalgo, Elvira Ramos García
1Centro de Salud. Quintanar del Rey. Cuenca. Centro de Salud Universitario Zona IV. Albacete. Spain.
Insights
Cardiovascular medication abandonment is higher when prescribed by general practitioners compared to specialists. Factors like drug cost, dosage frequency, and patient age influence adherence to cardiovascular treatments.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Context:
- Cardiovascular diseases represent a significant global health burden.
- Medication adherence is crucial for effective cardiovascular disease management.
- Understanding drug abandonment patterns is essential for improving patient outcomes.
Purpose:
- To determine the duration of therapeutic compliance and abandonment rates for cardiovascular prescription drugs.
- To identify prognostic factors influencing medication abandonment in cardiovascular patients.
- To analyze the impact of prescriber type (general practitioner vs. specialist) on drug abandonment.
Summary:
- A longitudinal study of 493 cardiovascular patients revealed a 39.4% abandonment rate for drugs prescribed by general practitioners versus 22.4% for specialists.
- Higher abandonment was observed with vasodilators and vasoprotective agents, while cardiac glycosides and ACE inhibitors showed longer survival times.
- Cox regression identified increased abandonment risk associated with multiple daily doses, lower drug cost (<100 ptas.), and younger age (<65 years).
Impact:
- Primary care prescriptions are linked to greater cardiovascular medication abandonment, potentially due to lower therapeutic effectiveness.
- Patient social and demographic factors significantly influence treatment adherence.
- Treatment characteristics, including drug cost and dosing, play a critical role in medication persistence.
Background:
Our purpose was to establish, by means of a survival analysis, the duration of therapeutic compliance and the probability of abandonment or prescription drugs in cardiovascular patients, as well as the prognostic factors that determine it.
Patients And Method:
Longitudinal observational study (1996-1998). By means of a consecutive sampling, 493 patients who initiated a cardiovascular treatment were selected. Through interviews, we obtained information on cardiovascular problems and treatment, concomitant diseases, consumption of other drugs and social and demographic variables. The consumption of prescribed drugs was established across 6 periodic observations.
Results:
During the observational period, 39.4% of drugs prescribed by the general practitioner (GP) were abandoned, as compared to 22.4% of those prescribed by specialists (p < 0.05). The degree of abandonment was significantly higher among consumers of vasodilators and vasoprotective agents. Cardiac glycosydes and angiotensin converting enzyme inhibitors were among the therapeutic subgroups in which a longer survival time was observed (average: 19.8 and 16.5 months, respectively). By a Cox regression analysis, we noticed that the risk of abandonment was higher in patients who took two or more doses of the drug per day (OR = 2.8; 95% IC, 21-37), in consumers of medicines with a daily cost lower than ptas. 100 (OR = 1.4); 95% CI, 1.0-1.8) and in subjects younger than 65 years (OR = 1.3; 95% CI, 1.0-1.8).
Conclusions:
A higher degree of abandonment of cardiovascular medication occurs when it is administered in primary health-care (i.e., drugs prescribed by the GP), mainly in relation to a greater prescription of agents with a low therapeutic effectiveness. Abandonment is influenced by patients' social and demographic factors and also by the specific characteristics of the treatment.